Pathology Report

Pathology Report: 1) Infiltrating (Invasive) Ductal Carcinoma Grade 2 – Starts in a milk duct but then the cancer cells break through the wall of the duct & spread into the fatty tissue. Cancer cells can then spread into the lymph nodes and to other parts of the body. 2) DCIS (Ductal Carcinoma in Situ) – Non invasive, still confined to the ducts where it started. If not removed it will progress and become an invasive cancer in 6 – 7 years. Because the two areas of cancer cells cover such a large area of the breast, this is a “bad breast”. To ensure that all of the cancer cells are removed, his recommendation is that a mastectomy + removal of a sentinel lymph node be done. The sentinel lymph node is examined under a microscope during surgery to look for cancer cells. If no cancer cells are seen by the pathologist, no other lymph nodes will be removed during the surgery. There is a 15% chance that on further examination of the lymph node (after surgery), the pathologist will find cancer cells. If this happens, you will have to return to surgery for an axillary lymph node dissection (removal of the remaining lymph nodes under the arm). This can cause swelling of the arm (lymphedema). For a simple mastectomy you will remain in the hospital for 24 hours. It is possible to do immediate breast reconstruction surgery at the same time as the simple mastectomy. This can be done with saline or silicone implants, or with you own tissue obtained from the tummy or the back. For a simple mastectomy + reconstruction you will remain in the hospital for 4 to 5 days. Reconstructive surgery does not need to be done at the time of the mastectomy. Studies have shown that women do psychologically better if they have the reconstruction at the same time as the mastectomy. There is a high probability that you will require chemotherapy. Even in the early stages of the disease, cancer cells can break away from the breast and spread through the bloodstream. These cells usually don’t cause symptoms, they don’t show up on an x-ry and they can’t be felt during a physical exam. But if they are allowed to grow, they can establish new tumors in other places in the body. Chemo is therefore give to women who are at risk of developing spread of the cancer (usually any woman with invasive breast cancer unless she has a very small area of tumor or has a grade 1 tumor). It usually lasts for 4-6 months and is given 1 time per month. He wants you to get the opinion of an oncologist (chemotherapy physician) before surgery. He recommends that you have genetic testing for the breast cancer gene. It is significant for you, for your sister and for any female child that you might bear. Should you test positive for this gene, the recommendation would be for a mastectomy also on the left and to have your ovaries removed. This is not a test that needs to be done right now. After treatment for breast cancer it is recommended that you do not get pregnant for 2 years. After that, studies have shown that women who do get pregnant & give birth have a decreased risk of recurrence. Two hormones in women – estrogen and progesterone – stimulate the growth of normal breast cells and play a role in many breast cancers. The hormone receptors are important because cancer cells that are ER or PR positive often stop growing if the woman takes a drug (Tamoxiphen) that blocks the estrogen and progesterone from binding to the cells. Tumors that are hormone receptor positive are less aggressive tumors. Your tumor tested strongly hormone receptor positive. This is good!! He did not palpate any enlarged lymph nodes. He could barely palpate the tumor. He feels that the invasive tumor is not that large. (Also good!!)